On 9 April, Secretary General of the United Nations Organisation Antonio Guterres addressed the UN Security Council, which for the first time discussed the pressing risks to the world due to coronavirus.
He called it as “the gravest test since the founding of this organization”. The ongoing pandemic has not occurred suddenly, since we were warned about such epidemics by many global institutions in the past also.
The Director General of the WHO, Dr Tedros A. Ghebreyesus, at the World Government Summit in February 2018 stated that “a devastating epidemic could start in any country at any time and kill millions of people because we are still not prepared. The world remains vulnerable.”
Moreover, according to the Global Health Security Index, a report which was published in October 2019, after using the public information to assess each country’s ability to prevent, detect and respond to health emergencies, assessed that national health security is “fundamentally weak” around the world.
Today, when the globe is in the grip of the pandemic, these comments seem even more clairvoyant. According to the report, the US is the “most prepared” nation (scoring 83.5), with the UK (77.9), the Netherlands (75.6), Australia (75.5) and Canada (75.3) behind it.
Thailand and South Korea were the countries in Asia that ranked 6th and 9th respectively in this category. India being highly populated stood at 57th rank. The UN Secretary-General in his latest speech also made a cautionary remark that “the weaknesses and lack of preparedness exposed by this pandemic provide a window into how a bioterrorist attack might unfold – and may increase its risks.
Non-state groups could gain access to virulent strains that could pose similar devastation to societies around the globe.” The threat of biological warfare or the next pandemic is not a myth, but a harsh reality. Therefore, it is pertinent to take into account how prepared we are in dealing with another pandemic or a possible bio-terrorist attack in the future, and the structural changes which are required to tackle with such a scenario in India.
According to the Centre for Disease Control and Prevention (CDC), a national public health institute of United States, “a biological attack, or bioterrorism, is the intentional release of viruses, bacteria, or other germs that can sicken or kill people, livestock, or crops.”
The characteristics of artificially created infections will be no different to natural ones and might create problems in detection, thus an effective disease surveillance mechanism is more than necessary. Advancement in technology has paved the way for an increasing number of people to study and modify pathogenic organisms.
As society continues to be in motion novel pathogens continue to pose challenges both at the point of initial contact and in far removed locations. The response to these challenges is the responsibility of Ministry of Home Affairs (MHA) which is the nodal ministry for bio-terrorism and it partners with Ministry of Health and Family Welfare (MoH & FW) in its management. MHA is responsible for assessing threat perceptions, setting up of deterrent mechanisms and providing intelligence inputs. MoH & FW will also provide the required technical support. The lack of present-day legal mechanism raises questions on how challenges of the day can be met.
For instance, the Government of India to tackle the Covid-19 pandemic was forced to implement provisions of the outmoded Epidemic Diseases Act, 1897 which was originally enacted to tackle bubonic plague in Mumbai (formerly Bombay) in former British India. This Act has no provision to empower the Centre to intervene in biological emergencies. It is to be noted that there is a systemic shift in the epidemiological concepts used in relation to the prevention and control of epidemic diseases.
The Epidemic Diseases Act focuses on scientific and legal standards that prevailed at the time when it was framed, but now it demands contemporary scientific understanding of outbreak prevention and response. For instance, the Act relies on the old approach to only emphasis on isolation or quarantine measures, but what is required today is reliance on scientific methods of outbreak prevention and control, such as vaccination, surveillance and organised public health response.
The Act does not emphasise on the ethical aspects or human rights principles that come into play during the response to an epidemic. Individual autonomy, liberty and privacy appropriately relevant to present-day need to be adhered to the extent possible, even during the enforcement of laws. Bio-disaster Management Guidelines, 2008 identifies gaps for improvement in the legal, institutional and operational framework to institute preparedness and put forth robust responses.
It states that it is time to repeal the old Act and to implement new legislation which can deal with the prevailing pandemic and foreseeable public health needs including emergencies such as Bioterrorist attacks and use of biological weapons by an adversary, cross-border issues, and international spread of diseases, etc.
It is necessary for the new legislation to clearly state the situations under which authorities may curtail the privacy, liberty and property rights of people. The act should articulate clearly to maintain standards in quality of care, rationality of treatment, cost of care, treatment protocol and ethical behaviour applicable to both public and private sectors and to be regulated through professional bodies with the engagement of people from both sectors. Since health is a State subject in the Indian Constitution, thus a resource crunch mires States into the trap of dependence and lackadaisical attitude. When India continues to grapple with inadequate health care systems, the foreseeability of issues like Biological terrorism remains a dream.
The twin problem of lack of medical staff at various levels and research and development continues to ring the danger bell for unprecedented situations and ways to deal with them. The best idea remains development of robust and integrated health care systems to deal with unprecedented situations.
The threats of biological agents can be controlled if protective systems and an action plan for the Guidelines are well synchronized, viz. developing an integrated ambulance network and accreditation for ambulances.
Furthermore, for implementing International Health Regulations, 2005 it is required to strengthen core capacity surveillance, border control at ports and airports, quarantine facilities, etc. India requires to develop level of epidemiological intelligence to keep a track on our adversaries’ bio warfare programmes.
Simple issues which are often neglected are clearly articulated terminologies and it is required to establish the threshold levels which are adapted to suit Indian requirements and clearly outline the role of various ministries and departments, which can help in effective implementation.
Therefore, an effective strategy to manage future epidemic or biological disasters not only requires structural changes but most importantly it also requires support of empowered community which can lead to enabling community action.
The writers are lawyers at the Supreme Court of India and Allahabad High Court.